Development of Interactive Multimedia Health Informatics CD … · 2013. 7. 3. · factors;...
Transcript of Development of Interactive Multimedia Health Informatics CD … · 2013. 7. 3. · factors;...
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Development of Interactive Multimedia Health Informatics CD-Rom for
Aboriginal Health Workers - Case Study: Tuberculosis (TB)
Faeka El Sayed, Jeffrey Soar1, Zoe Wang
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Department of Information System, Faculty of Business,
University of Southern Queensland, Toowoomba
Email: [email protected]
Abstract
Aboriginal and Torres Strait Islander health workers are key providers of primary health
services to Aboriginal communities, especially in remote and rural areas. Their roles often
involve them being overloaded with competing demands. Despite all of this there has been
limited attention given to the maintenance and ongoing enhancement of their skills and
knowledge following the completion of formal training.
A culturally appropriate interactive multimedia self-paced health program as a mechanism to
improve the accessibility and the use of scientific data and information for health purposes was
proposed as a basic method for better supporting Aboriginal and Torres Strait Islander primary
health care workers in their practice locations. This study involved four phases: program needs
assessment, identification of the key factors that should be considered in developing the CD-
Rom, model development, and formative evaluation for the model.
This paper is a case description for the third phase of the study: the development of a culturally
appropriate interactive multimedia health informatics CD-Rom for Aboriginal and Torres Strait
Islander health workers.
Background to the Project
Aboriginal and Torres Strait Islander Australians face substantial problems in accessing
appropriate primary health care services due to large distances and the cost of logistics involved
in transporting people to hospitals or clinics (Gruen, Weeramanthri & Bailie 2002). Cultural
barriers are also regarded as major factors in reduced access by Aboriginal and Torres Strait
Islander Australians of mainstream health services (QldHS 2007). Aboriginal and Torres
Strait Islander health workers (ATSIHWs) play a very important role overall in health services
and are considered key providers of primary health services to their communities, particularly
in remote and rural areas. They are often overloaded with competing demands. The pressure to
know a little about everything is a common theme (Grant 1992) (Pacza, Steele & Tennant
2001).
As reported by (Soar & Yuginovich 2006) there has been limited attention given to the
maintenance and ongoing enhancement of ATSIHWs’ skills and knowledge following the
completion of formal training. Provision of education and skills transfer as well as professional
support to ATSIHWs would help them to enhance their skills so as to make an even more
effective contribution (Gruen, Weeramanthri & Bailie 2002).
(Lazakidou, Ilioudi & Daskalaki 2006) stressed the importance of more clearly recognizing and
appreciating the role of information technology in health care education. (Collyer 2006)
suggested that information technologies could offer potential for improving continuing
1 Department of Information System, Faculty of Business, University of Southern Queensland, Toowoomba.
2 School of Nursing and Midwifery, Faculty of Health Sciences, Australian Catholic University, Brisbane
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education of ATSIHWs and consequentially for improving the quality of care provided within
their communities. Using the capability of multimedia presentation technology ensures the
effectiveness of content delivery to health workers (Chetley et al. 2006). (Geissinger 2001)
supports using a CD as a delivery mechanism for continuing professional education for health
practitioners in rural areas and suggests also that health workers living in remote areas need to
be provided with a CD player as an add-on component if it is not supplied as part of their
original computer equipment.
The benefits of a culturally appropriate interactive multimedia informative health program for
improving the accessibility and the use of scientific data and information for health purposes is
explored in this research. Expectations are that this would give ATSIHWs opportunities to
more independently control their learning within an attractive and interesting environment, and
improve their capacity for quality of healthcare delivery and overall health outcomes (Phillips
1997).
A needs assessment, as a first step in program development, was carried out using qualitative
semi structured interviews with key stakeholders. The assessment indicated the opportunities
for additional means to help deliver a sustainable, efficient and culturally acceptable program
for ATSIHWs. The needs and opportunities for improving services for ATSIHWs are
supported by previous published studies and the findings of the qualitative semi structured
interviews that were part of this research.
The second phase is the identification of the key factors which need to be considered and that
would impact the model development. The identification began with a systematic review of
literature. This was followed by qualitative semi structured interviews with diverse key
stakeholders and explored their expectations and recommendations. The main findings revealed
that the most important key factors could be categorized under three main issues: cultural
factors; information technologies literacy and availability; and interactive multimedia factors.
Cultural factors included cultural inclusivity, oral cultural, pre-existing knowledge, and
Aboriginal learning styles. Interactive multimedia factors were the requirements for the
process, fitting and design of the program.
This paper explores the third phase in this study which is a detailed description of the
development of the interactive multimedia informatics CD-Rom guided by the results and
recommendations from the first and second phases of the study and supported by previous
published studies.
Why choose Tuberculosis (TB) as a Focus for the Model?
In 1991, the World Health Assembly (WHA) resolution recognized TB as a major global public
health problem (Uplekar et al. 2006), and one of the most important causes of death in adults
which is strongly associated with social and economic inequalities (WHO 1998).
On the national level, (Bastian & Krause 2008) highlight that TB is a global health emergency
in which Australia has responsibilities and the capacity to make a difference both within and
beyond our shores. Australia has a low incidence of Tuberculosis (TB), which has remained
constant for over a decade. However, the incidence is not the same across the population;
immigrants and Aboriginal and Torres Strait Islander Australians are most affected and have
rates many times those of non-Aboriginal and Torres Strait Islander (NTAC 2002) (Simpson,
Clark & Knight 2006) (Bastian & Krause 2008).
The main risk factors for Tuberculosis are poverty, overcrowding, malnutrition, diabetes
mellitus, smoking, alcohol abuse, and advanced renal diseases. All those factors are common
among many Indigenous people (Thomson N et al. 2008). (Oest et al. 2005) reported in his
study about Tuberculosis services for indigenous and immigrant populations in New Zealand,
that treatment is often discontinued prior to completion once the symptoms are resolved.
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Tuberculosis needs a long time for uninterrupted treatment. Patients need assistance from
health workers to successfully complete their treatment and be cured (Barlett 1995). The poor
treatment and inadequate control of anti-tuberculosis drugs will result in the development of
drug-resistant strains that may make Tuberculosis incurable (WHO 1998).
Important measures for preventing TB include public education and improving awareness-
raising of TB through:
1) Education and training among health care workers in order to promote early detection, and to
consider TB in at-risk patients,
2) Increasing patient awareness of available treatment,
3) Education and empowerment of high- risk groups and their families/cares which are
provided by ATSIHWs. Patients who have this knowledge are less likely to delay diagnosis, a
delay that could result in transmission of the disease to uninfected persons, (NTAC 2002)
(Miller et al. 2003) (Bastian & Krause 2008).
Model development
(Pellekaan & Clague 2005) urge to the vital need for a sound primary health care and education
program implemented by dedicated persons toward health and wellbeing for Aboriginal
Australians. An Interactive Multimedia CD-Rom health program is required, providing basic
information about Tuberculosis (TB) for ATSIHWs using culturally perceptive pedagogy
fitting “the oral tradition”. This project was developed and guided by the principles of iterative
software design and development.
Audience
The target audience for this course is ATSIHWs, especially those who are caring for persons
with or at high risk of TB disease or infection. Previous studies revealed the initial phase of
learning in any new program is based upon the learner's background knowledge, which is a
sum of all abilities acquired as a result of exposure to earlier learning experiences. A clear
audience profile regarding the age, educational level, corporate culture, needs and expectations,
level of computer literacy, background knowledge, motivation and interest will provide the
program producer with valuable information for script development, and media selection, as
well as help create a concept of delivery that increases the program's chances of success
(Harrison 1990) (Villamil-Casanova & Molina 1996) (Fedak 1999) (Cartwright & Cartwright
1999).
In the planned model the development of a general design was attempted, simple without
affecting the main objective of the model which is provide the learner with important useful
health information. During the assessment stage, and from a review of published literature and
reports, the profile of ATSIHWs and their way of learning and cultural principles were
explored and adapted in the program development. They are the following: 1- ATSIHWs are
used to learning from stories, and the interactive multimedia health model's content should not
rely on text, but depend on narration and visual demonstration. 2- Elements of traditional and
cultural aspects should be incorporated into the model's content. 3- Model content should build
on the pre-existing knowledge of ATSIHWs.
Goal
The purpose of the proposed application and the expected result must be clear and be
considered throughout the planning and development phase of the program (Villamil-Casanova
& Molina 1996). The impact of the program often becomes its overall objective or goals
(Cartwright & Cartwright 1999). Developing an interactive multimedia health informatics
program that is sustainable, efficient, and culturally relevant to ATSIHWs is the main goal of
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this project. The expected results are: 1) the model is to be considered as a continuing
professional development approach that enables ATSIHWs to constantly upgrade their skills,
keep them updated with changes, and provide them with basic information about TB including
type, diagnosis and early detection, management, and prevention procedures. 2) The model
raises the awareness about TB as a major global public health problem and prepares ATSIHWs
for potential TB outbreaks. 3) The model can be used to support ATSIHWs in their health
education and promotion roles within their own communities.
Task Analysis
The task analysis is a hierarchical outline of the model content in which splitting a topic into
the smallest measurable steps and dividing the final goal into enabling objectives by using the
pyramid analysis technique to produces a learning map or flowchart which forms the main
structure for the multimedia program (Cartwright & Cartwright 1999; Harrison 1999;
Riptoningrum 2003). A thorough task analysis at the start of the project is crucial to clarify a
clear set of educational objectives and the information to be taught, as well as to assist in
designing the details, and to determine an effective learning sequence for the program (Boyle
1997; Cartwright & Cartwright 1999; Harrison 1990; Riptoningrum 2003). A good learning
sequence should begin with skills that only require the learner to, combine skills they already
have, and should follow standard educational practice (Alessi & Trollip 2001) (Tomita 2003).
Figure (1) illustrates task analysis for the Tuberculosis CD-ROM model in which:
1- Model starts with an introduction and general information about the topic followed by more
detailed and specific information.
2- It clarifies the educational objectives regarding detection, treatment and preventive measures
of Tuberculosis and reveals the anticipated model design.
Fig (1); Learning Map
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Model Objectives
With any health education program, clearly defined goals, and measurable objectives are
essential to facilitate effective model design, and to help in the determination of the learning
resources required. They are also considered the measurements of the evaluation for the
program (Grant 1992; Kern 1998; Tomita 2003). Each objective should achieve the program
aim, be stated precisely and specify the appropriate measurable outcomes (Boyle 1997;
Harrison 1999). The success of the project can then be decided by measuring how well the
outcomes have been achieved (Boyle 1997).
There are two types of objectives. Learner objectives provide a clear statement of the program
outcomes, results the learner is expected to accomplish, and help the learner by pointing out
important topics. Design objectives provide guidelines for media production decisions, help the
developers prescribe appropriate activities, are more focused on required topics than on
tangential issues, and determine the most effective delivery methods (Cartwright & Cartwright
1999; Gagne, Briggs & Wager 1992; Hannafin & Peck 1988; Harrison 1999; Kennedy,
Petrovic & Keppell 1998)
Design Objectives
Design objectives are about how to turn a boring subject matter into an interesting screen-based
unit (Harrison 1999). The program was designed to have the following features:
1- Navigation: simple and easy to use,
2- Screen: standard screen components with the presence of a main menu,
3- Interactivity: interaction through quiz
4- Cultural appropriateness by using storytelling, and
5- Learner control of the program
Learner's Objective The learning objectives provided in the Tuberculosis informatics program developed in the
present study include providing participants with basic knowledge of early detection,
treatment and preventive measures of Tuberculosis relevant to Queensland health.
Essentially, this was accomplished by giving ATSIHWs an introduction to the different types
of the disease and the life cycle of the microbe.
On successful completion of this program Aboriginal and Torres Strait Islander health workers
will have moderate knowledge of early detection and preventive methods of Tuberculosis.
After completing Module One in this program they will be able to:
Describe the classification system for TB.
Identify ways in which TB is spread.
Identify conditions that increase the risk of TB infection transmission
Describe TB signs and symptoms.
After completing Module Two in this program they will be able to:
Describe the pathogenesis (life cycle) of Mycobacterium Tuberculosis
Identify conditions that increase the risk of TB infection progressing to active TB
disease
Identify high priority groups that should be tested for latent TB infection (LTBI)
After completing Module Three in this program they will be able to:
Identify the major components of TB diagnostic procedures.
After completing Module Four in this program they will be able to:
Identify anti tuberculosis medications
Describe treatment regimens for TB disease
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Describe patient monitoring.
List common adverse drug reactions to anti-tuberculosis medications.
After completing Module Five in this program they will be able to:
Identify three levels of infection control (IC) measures to prevent the transmission of
TB (administrative, environmental, and personnel controls)
Identify BCG vaccination.
Identify the roles of health professionals in preventing Tuberculosis.
Identify the roles of patient in preventing Tuberculosis.
Multimedia Application Design Considerations
At this stage we consider other factors relevant to model design. They are the configurations of
computer that will run the model, multimedia building blocks that form the model, the
interactive multimedia methodology and the authoring program that use for model
development.
Definition of Computer Configurations
An important planning consideration is to define the type of machine that will run the
application. The average machine configuration is 33-66Mhz, 8-16 RAM, double speed CD
ROM, 480-640 color monitor; video card 1024x768 with 65,536 color and 8- 16 bit audio
board (Rathbone 1995) (Villamil-Casanova & Molina 1996).
Multimedia Building Blocks These encompass the multimedia materials which form the multimedia model. They are usually
produced using a variety of software applications and then assembled together using authoring
programs (Villamil-Casanova & Molina 1996). According to (Fletcher 1990) and (Knebel
2000) people retain only 20 percent of what they hear; 40 percent of what they see and hear;
and 75 percent of what they see, hear, and do. The model could therefore be more effective if a
variety of communication modes are used to present the same concept which fulfill the
different learning styles of all audience members (Villamil-Casanova & Molina 1996)
(Cartwright & Cartwright 1999).
In the model video footage was developed using movie maker software and drawn pictures
colored using black magic coloring software. The narrated stories were recorded directly over
the authoring program, and a search of the web produced the graphic medical pictures, icons,
and Aboriginal music.
Choosing an Interactive Multimedia (IMM) Methodology and Authoring Program The decision of choosing the final interactive multimedia methodology for the model was
based on the type of learning and methods of model delivery ( via the World Wide Web or
Using CD Rom), and depended on the functions of interactive multimedia (Cartwright &
Cartwright 1999) (Alessi & Trollip 2001). Models that combine methodologies will have a
greater likelihood of being effective (Alessi & Trollip 2001). Tutorials and storytelling was
used as the most simple and culturally appropriate interactive methodologies for presenting
information and concepts.
An authoring program is a software program that brings all media elements created together
into a final project and allows an author to create multimedia applications (Luther 1994) (Ivers
& Barron 1998). There are many software programs that can be used to author a multimedia
project such as Microsoft Power Point, Hyper-Studio, Author ware, and Icon Author. The
selection of the authoring tool depends on the job needs and on the choice of interactive
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multimedia methodology (Luther 1994) (Villamil-Casanova & Molina 1996) (Ivers & Barron
1998). Microsoft PowerPoint was chosen to be the authoring program software to provide
informative materials on CDROM with meaningful links between the various modules of the
model.
Model Content and Structure
Medicine, public health, understanding of traditions, and development of social awareness are
all important; but it is impossible for health workers to learn everything in detail. There is a
need to determine and cover what is essential to know. (Werner & Bower 1982) in his book
"Helping Health Workers Learn", identified important points that should be taken into
consideration when developing a health program for community health workers. They are:
- Program content should aim to teach what is most important and essential to know.
- Learning must relate to life so program content should be based on what is already familiar to
health workers, and should start with their own knowledge and experience within communities
and individuals.
- In developing the program content, it is important to look at the social and physical causes,
symptoms and effects on people's health and lives.
- Health workers learn better and remember longer if they understood the reason why things
happen and what needs to be done.
- The program should discuss health matters in clear, simple language that everyone can
understand.
(Harrison 1990) suggested an existing training material could be used as program content in the
development an interactive multimedia health program.
Programs have successful outcomes only in so far as they introduce the appropriate ideas and
opportunities to a group in the appropriate social and cultural conditions (Pawson & Tilley
1997). ATSIHWs come from many different backgrounds, and have different skills and
knowledge. Some are highly literate, while for others English is a second language. Some live
in large cities, and others live and work in remote communities (Barlett 1995). It is hard to meet
every ATSIHW’s needs using the same program structure.
Model Structure
In order to present the content clearly, the completed program consist of five independent
modules with a total of 16 learning objectives distributed throughout the modules. The learning
objective were outlined descriptively and in detail in the section called “Program Objectives”.
The first module contains a story describing a health situation which gives introductory basic
general information about Tuberculosis. As the learner progresses through the program
modules, they are informed about Tuberculosis pathogenesis, diagnosis, treatment, prevention
and prognosis of the disease in a storytelling, tutorial, and narrative manner. Each module ends
with a quiz. Throughout the program there are on line national and international links to update
information and keep the health workers in touch with mainstream health. Users can enter the
program through any module from the main menu depending on their needs and interests.
Model Content
Each module gives information about a special topic to achieve the previously specified
objectives, such as: Module One: Introduction and basic general information about
Tuberculosis. Module Two: Why TB happens? What are bacteria and how can it can affect our
body? What is the life cycle of bacteria inside our body? Module Three: How to recognize
Tuberculosis? Diagnosis of TB through observation, history, and physical examination
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Module Four: Treatment and compliance with treatment. Module Five: Prevention is a
reflection on the long term need for the community, and the role of health workers and patient
in prevention. Aboriginals tend to be concerned only with the present and conceptualize the
future as a continuation of the present (Hausfeld 1977). Prevention is expressed in the model in
the form of public health measures and advice to be accepted by Aboriginals, such as reducing
crowding and care of the environment.
How the Story Written? The content and style of the story was obtained from document research about Aboriginal
cultural and healing belief (Devanesen 2000). Anthropology case studies of remote Aboriginal
communities in Australia were utilized to draw, realize and tell a detailed story (Saethre 2007).
That followed by the transformation of the story scripts and creation of a scenario that can be
used to suit the health topic. The story is then reviewed and revised and affirmed by health
workers participating in the study.
Medical Terminology
Interview results identified the friendliest approach to define health problems for Aboriginal
communities are to divide medical terminology into a smaller number of conditions that have a
common cause. This approach has been supported by (Barlett 1995) who argued that to define
health problems for Aboriginal communities in terms of diseases does not help the
communities much, but focusing on health problems by looking at the causes first, as it is
explained in the table (1):
CAUSITIVE FACTORS HEALTH PROBLEMS
LAND Poor physical environment: 1-Environmental health issues
include water supply, waste disposal, shelter (adequate and
appropriate space for numbers of people), domestic and
personal hygiene, and dust.
2- Housing and health hardware should be determined by
how people want to live. Aboriginals enjoy living outside.
Infectious diseases
MIND Social and spiritual environment : such as unemployment,
racism , lack of access/knowledge of country, loss of
language/stories, inappropriate social behaviors
Alcohol/ substance abuse/
violence/ STDs, and
mental health problems.
BODY Poor nutrition High blood pressure, heart
diseases, obesity, diabetes,
increases in infectious
illness, poor development.
Table (1), Source (Barlett 1995)
Clarification of Health Information The most important criterion by which the learning content in the program and medical
resources are selected is that they focus on up-to-date information and provide comprehensive
information about communicable diseases identification, reporting, control and prevention.
Medical learning resources which meet this criterion are derived from different national and
international organizations. They include the World Health Organization (WHO 2004), U.S
Agency for International Development (USAID 2011), Centers for Disease Control and
Prevention (CDC) Division of Tuberculosis Elimination (DTBE) (CDC 2010), the" Control of
communicable Diseases Manual" by (Heymann 2004), and Queensland health's communicable
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Diseases Branch who is responsible for surveillance, prevention and control of communicable
diseases in Queensland and is provide information on communicable diseases as a key
resources for health professionals (QLDHealth 2010a),
The skills and knowledge that health workers specifically need to detect cases of pulmonary
TB, inform patients about TB, and monitor the success of TB case detection and treatment at
health facility level can be obtained from the WHO guide, and the related set of training
modules for health facility staff can be obtained from " How to Organize Training for Health
Facility Staff on TB Control" (WHO 2004).
TB treatment regimens vary from country to country. The specific information regarding
diagnosis of Tuberculosis, treatment guidelines, TB infection control guidelines, management
of TB patients, and vaccination program was provided by Queensland Health’s website for
health professionals about Tuberculosis (QLDHealth 2010b).
Model Design
The goal of the design phase was to develop a framework for the "Interactive Multimedia Self-
Paced Informative Health Model" interactive multimedia CD-ROM (Fig 2) which is intended
to provide information about Tuberculosis to ATSIHWs.
The design was guided by the data collected from the interviews as a solid base, and
information from the literature review was added. There was limitation and simplicity in the
design as a result of concern about the computer’s capacity to run large multimedia programs.
Figure (2) Model framework design
The design process began with documenting the design decisions through storyboards,
followed by discussion regarding the navigation structure and the graphic design for the
interactive multimedia model.
Storyboard
This is the learning map of the content, sequence and characteristics of a multimedia model in
pictorial form which follows the development phase. It is used to reflect on the flow of the
applications (Hofstetter 1997) (Cartwright & Cartwright 1999). Having good objectives based
on and related to proper task analysis, and writing the program content based on those set
objectives, is the first cornerstone of a good self-directed learning model (Piskurich 1993). The
design phase uses the conclusions from the assessment and task analysis phase to build a road
map for development (Alessi & Trollip 2001) (Lee & Owens 2004).
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Creating a storyboard for a model is followed by creating script for it. A script is a complete
specification of the text and narration in a multimedia application. It helps the designer to role-
play the model from the viewpoint of a user and identify any missing elements (Hofstetter
1997). Figure (3) illustrates an example of a planned program storyboard.
Figure (3) Storyboard
Interactivity and Learner control
(Frater & Paulissen 1994) (Boyle 1997) argued that knowledge is neither pre-given, nor
stamped in by the impact of external stimuli. It is constructed and validated through interaction,
which is the most important aspect of a learning program, aside from the content itself.
Multimedia has the potential to provide learners with educational experiences that traditional
text-based methods cannot; they are often described as 'interactive' (Albion 2000).
Interactivity refers to activities performed by both the learner and the computer. These activities
conduct an interchange (Orr, C.Golas & Yao 1993) (Mooney & Bligh 1997) (Cartwright &
Cartwright 1999).They involve the learner in an active learning method which can serve to
maintain attention, create new knowledge, and improve achievement (Barron & Orwing 1995).
Learner control refers to the degree to which learners are allowed to take an individual path
through the material and to take charge of the instructions and the learning environment. It is
the ability of the user to cause things to happen or to interrupt the flow of information in a
program. The ability to do this is one advantage of multimedia over video or television (Orr,
C.Golas & Yao 1993) (Abrams 1996) (Albion 2000).
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Determination of the level and degree of interactivity is needed to accomplish the program
goals. It is of particular importance to decide whether the program will provide questions,
methods of answers and computer feedback (Villamil-Casanova & Molina 1996). For many
medical multimedia programs the interactivity consists of button clicking or electronic page
turning, and this is the lowest level of interactivity where the computer is performing tasks by
the user (Mooney & Bligh 1997)
The truly interactive multimedia computer-based programs aim to establish an educational
'conversation' between a user and a computer and emulate interpersonal communication (Orr,
C.Golas & Yao 1993). This can be achieved using features such as feedback on strengths and
weaknesses and progress charts linked to learning activities and self-assessment (Mooney &
Bligh 1997). In the planned model the interactivity is founded through a series of interactive
questions at the end of each module followed by helpful feedback.
Navigation Structure One of the challenges in the model design was to present the program material in such a way
that the user will not get lost or confused. A clear notion of how the material will be organized
and how the user will navigate from screen to screen is therefore essential (Hofstetter 1997).
Multimedia technology enables the designer to design applications with several layers of
information, each accessible by means of navigational tools and each containing several
different multimedia building blocks.
The connections and links among various sections of the multimedia application are called
navigational structures. There are five basic navigational structures which design the flow of a
multimedia application: the linear, the menu, the hierarchical, the network and the hybrid
structures. In practice, several of these schemes may be mixed in a single project (Villamil-
Casanova & Molina 1996) (Phillips 1997).
The menu and the linear navigational structures were adapted in the design of this CD ROM
multimedia program Fig (4), (5).
Figure (4) the menu navigation structure
Source (Hofstetter 1997)
Figure (5) the linear navigation structure
Source (Hofstetter 1997)
(Shank 2011) recommended that the learning environment for the program is designed to be
more direct as this is the best approach for learners that are new to information technology. A
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CD- ROM multimedia program need to have a main page, table of contents, or main menu
where the user may view all of the contents of the CD- ROM and may be informed about how
to navigate and find information (Tomita 2003).
The planned model was designed to have limited instructions, and be as straightforward to use
as possible with full learner control of content. The model does not require completion of a
certain topic before jumping into the next topic, making it easy for learners to freely and easily
search for specific information. Users can exit the program at any time. This type of program
has many limitations associated with behaviorism, however it holds user attention much longer
than traditional methods of learning (Conrick 2006).
The navigation design is presented in a flowchart as a logical diagram that illustrates the steps
involved in an interactive decision-making process and includes the general order in which the
learner will encounter directions, choices, presentations, interactions, remediation and
finalization (Hofstetter 1997) (Alessi & Trollip 2001).
The model frameworks in figure (6) and (7) are the underlying structures of the planned model.
These are designed to provide information in the form of tutorial presentations (P) within each
module (M) followed by a short Quiz (Q) and feedback (F). The tutorial presentations (P) in
modules one, two and four are offered in the form of storytelling videos and in modules three
and five are presented in the form of Power Point presentations.
Multimedia Model for supporting Indigenous Health Workers in Preventing Communicable Diseases
A Research Proposal Submitted for Candidature for the degree of Doctor of Philosophy by Faeka El Sayed
2010
Title
Main
Menu
M1
Links
Exit
End
M
M
M
M
M
Start
M2 M3 M4 M5
1
P
Q
F
Figure (6) Flowchart of a Model framework
Model modules are connected by permanent links that are used to link related screens in the
simplest form and to allow the user to return to the main menu or exit the program from any
screen in the program. The design framework provides two methods for navigation. The
Systematic User’s Guidance (linear method) is present only in the presentations (P) of each
module. The random access browser, a menu or web-like structure, provides the freedom to
explore the information at any point in the program and to move between the different modules.
This navigation of the design framework ensures the effectiveness of learner control. The
presence of optional quizzes followed by feedback at the end of each module, which corrects
the learner’s answers and verbally acknowledges achievement, provides the interactive learning
experience.
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Title
Main
Menu
Module
True
Ask a question
False
Links
Exit
End
M
M
M
M
Start
Proceed to the
next question
Provide feedback
Figure (7) Flowchart of quiz
Each module, whatever forms it is in (presentation or story), is primarily narrative -based, and
is supported by text, images, drawings, figures and links to medical references.
Design objectives and learner control of the program were achieved through the following
functions:
1- Learners are able to make better sequencing decisions for their learning activities
2- Learners are able to temporarily end the program and return to it later
3- The screen buttons are visible and remind learners of things that can be done
4- The menu list is present throughout the program and the options available are clear
5- The main menu is easy to access in the entire program
6- The mouse is used as a simple mode of control of the program
7- The presence of a repeat button in each slide throughout the program provides a way for the
learner to control hearing of the instructions and the narration.
Screen Graphic Design
(Harrison 1990), (Ivers & Barron 1998) and (Cartwright & Cartwright 1999) identified some
important factors that should be considered in any program screen design, which help the
learner interact and concentrate with the content of the program. Those factors are:
1- The screen should be simple, consistent and intuitive
2- Readable text on the screen and clear effective writing
3- Presence of standard screen types throughout the program
4- Presence of separate main menus summarizing the program content and allowing learners to
jump directly to a point of interest
5- For consistency, the screen template used in the project should contain defined functional
areas.
The exact design of the screen template depended on the type of information presented and the
authoring program used, which depend on the primary purpose of the designed screen (Ivers &
Barron 1998) (Cartwright & Cartwright 1999).
There was more than one template used in the project. These are: a template for information
(Screen Template, fig 8), another for questions (Interaction Screen, fig 9), and a third for the
menu screen (Navigation screen, fig 10).
14
Fig (8) Instructional Screen Template
Fig (9) Question Template
Fig (10) Menu Screen Template
Program Implementation
The program design was directed by the adult learning, population heath and medical education
learning approaches. It was influenced by constructivist and socio-cultural learning theories.
15
Story transcripts were sent to artists to portray the pictures. The graphics were produced using
Black Magic painting software. The material collected and the narration used were recorded
direct on the authoring program software. The main designs of screen templates were specified.
The media modules were assembled using Movie Maker software to produce the stories in the
form of video clips. Following the completion of the storyboard, the program was developed
using PowerPoint software.
Conclusion
A culturally appropriate interactive multimedia CD-Rom informatics model as a mechanism to
improve the accessibility and the use of scientific data and information for health purposes was
proposed as a basic method for better supporting Aboriginal and Torres Strait Islander primary
health care workers in their practice locations. A CD-Rom was developed guided by the results
and recommendations from a needs assessment through the use of qualitative interviews with
key stakeholders and supported by previous literature.
The development procedures started with identification of the audience’s profile, determination
of the program’s goal, preparation of the task analysis and specification of the program
objectives. This was followed by determining computer configuration required, and the
multimedia blocks to be used in the program. Tutorials and storytelling was used as the
interactive methodologies for presenting information and concepts. PowerPoint software was
chosen to be the authoring program software. Program content and structure was decided upon
and a transcript to the storyboard was developed, which described in detail the interactivity,
navigation, learner control, and screen design.
It is envisaged that through establishing this interactive multimedia CD-ROM informatics
model , ATSIHWs will be encouraged to be self directed learners, improving their up to
date knowledge and information. It is also hoped that it may also encourage ATSIHWs to
pursue other health care courses. Furthermore, it is envisaged that this model will empower
ATSIHWs and support them in their practice locations, especially those in remote and rural
areas. The CD-ROM will be sent to key stakeholder with various backgrounds for formative
review as the next stage in the study.
References
Abrams, AH 1996, Multimedia Magic: Exploring the Power of Multimedia Production, 0- 205-
17867-7, Allyn & Bacon, Massachusetts.
Albion, PR 2000, 'Interactive multimedia problem-based learning for enhancing pre-service
teachers’ self-efficacy beliefs about teaching with computers: Design, development and
evaluation', University of Southern Queensland.
Alessi, SM & Trollip, SR 2001, Multimedia for learning: methods and development, 3 edn, 0-
205-27691-1, Massachusetts.
Barlett, B 1995, Aboriginal Health Worker' Guide to family community and public health, 0
9596881 1 0, Central Australian Aboriginal Congress Publication, Central Australia.
Barron, AE & Orwing, GW 1995, Multimedia Technologies for Training : An Introduction 1-
56308-262-4, Libraries Unlimited,INC, Englewood, Colorado.
16
Bastian, I & Krause, V 2008, Tuberculosis in Australia, Australian Medical Association,
viewed 30 January 2010, <http://www.ama.com.au/node/2950>.
Boyle, T 1997, Design for Multimedia Learning, 1st edn, 0-13-242215-8, Prentice Hall,
London.
Cartwright, SR & Cartwright, GP 1999, Designing and producing media-based training, 0-
240-80325-6, Focal Press, USA.
CDC 2010, Centers for Disease Control and Prevention Division of Tuberculosis Elimination
20 january 2010, <http://www.cdc.gov/tb/about/default.htm>.
Chetley, A, Davies, J, Trude, B, McConnell, H, Ramirez, R, Shields, T, Drury, P, Kumekawa,
J, louw, J, fereday, G & Nyamai-Kisia, C 2006, Improving health, connecting people: the role
of ICTs in the health sector of developing countries, Healthlink Worldwide, AfriAfya, the
Institute for Sustainable Health Education and Development,
<http://www.asksource.info/pdf/framework2.pdf>.
Collyer, NE 2006, Training Community health workers: Using Technology and Distance
Education, Frontier Education Centre, Health resources and services administration's office of
Rural Health, United State, 19 January 2010,
<http://74.125.155.132/search?q=cache:N0c0Ec_e9EgJ:ruralhealth.hrsa.gov/pub/trainingfrontie
r.asp+Rural+health+policy-training-+fronter&hl=en&gl=au&strip=1>.
Conrick, M 2006, Health Informatics, Transforming Healthcare with Technology, 1st edn, 0 17
012731 1, Australia.
Devanesen, D 2000, Traditional Aboriginal Medicine Practice in The Northern Territory,
World Health Organization: Centre for Health Development, Awaji Island, Japan, 11-13
September.
Fedak, B 1999, 'Interactive learning and Multimedia Education with special focus on the
framework design of an Interactive CD-ROM: Light and Architecture', Dalhousie University-
Daltech.
Fletcher, JD 1990, Effectiveness and cost of Interactive Videodisc Instruction in Defense
training and Education, Institute for Defence Analysis, Arlington, USA, 22 March 2010,
<http://www.eric.ed.gov/ERICDocs/data/ericdocs2sql/content_storage_01/0000019b/80/23/06/
f6.pdf>.
Frater, H & Paulissen, D 1994, Multimedia Mania, 1- 55755 - 166 - 9, Abacus, USA.
Gagne, RM, Briggs, LJ & Wager, WW 1992, Principles of Instructional Design, 4th edn, 0-03-
034757-2, USA.
Geissinger, H 2001, Continuing professional development for rural and remote health care
practitioners, Canberra, 4-7 March.
Grant, M 1992, Caring in the country: developing HIV/AIDS training and support for rural
health and welfare workers, 0 7306 3130 3,Commonwealth department of Health, Housing and
17
community services, Deakin University Publishing Unit, Health Education Centre, Barwon
South Western Region Incorporated Victoria, Australia.
Gruen, RL, Weeramanthri, TS & Bailie, RS 2002, 'Outreach and improved access to specialist
services for indigenous people in remote Australia: the requirements for sustainability',
Epidemiology Community Health, vol. 56, pp. 517-21.
Hannafin, MJ & Peck, KL 1988, The Design, Development, and Evaluation of Instructional
Software, 0-02-349990-7, Macmillan Publishing Company, New York.
Harrison, N 1990, How to Design Effective Computer Based Training, The McGraw-Hill
Training Sries, 0-07-707354-1.
---- 1999, How to design self-directed and distance learning programs, 0-07-0271000-3,
McGraw-Hill, New York.
Hausfeld, RG 1977, 'Social, ethic and cultural aspects of Aboriginal health', Australian Family
Physician, vol. 6.
Heymann, DL 2004, Control of Communicable Diseases Manual, 18 edn, 0-87553-034-6,
American Public Health Association, Washington DC, USA.
Hofstetter, FT 1997, Multimedia Literacy, 2nd edn.
Ivers, KS & Barron, AE 1998, Multimedia Projects in Education: Designing, Producing, and
Assessing, 1-56308-572-0, Lbraries Unlimited, Inc, Englewood, Colorado.
Kennedy, G, Petrovic, T & Keppell, M 1998, 'The Development of Multimedia Evaluation
Criteria and a Program of evaluation for Computer Aided Learning', paper presented to
ASCILITE 98, The 15th Annual Conference of the Australian Society for Computer In
Learning in Tertiary Education 98, University of Wollongong, Australia.
Kern, DE 1998, Curriculum development for medical education; a six steps approach
The John Hopkins University Press, USA, 2 January 2010, 0-8018-5844-5,
<http://books.google.com.au/books?id=oSOHCmCNIvYC&dq=Kern+DE,+Thomas+PA,+Ho
ward+DM,+Bass+EB:+Curriculum+Development+for+Medical&printsec=frontcover&source
=bn&hl=en&ei=pSQ_S-
njOI_WsgOhvKFK&sa=X&oi=book_result&ct=result&resnum=4&ved=0CBQQ6AEwAw#v
=onepage&q=&f=false>.
Lazakidou, AA, Ilioudi, C & Daskalaki, A 2006, 'Potential Benefits and Challenges of
Computer-Based Learning in Health', in Handbook of Research on Informatics in Healthcare
and Biomedicine, 1st edn, Igi Global, pp. 119-25.
Lee, WW & Owens, DL 2004, Multimedia-Based Instructional Design: Computer-based
training, Web-based training, Distance broadcast training, Performance-based solutions, 2
edn, 0-7879-7069-7, PFeiffer.
Luther, AC 1994, Authoring Interactive Multimedia, 0-12-460430-7, Academic Press Limited,
London.
18
Miller, CM, Pozsik, C, Cobb, J, Field, K, Fraire, M, Jones, S, Pearson, J & Shaw, T 2003,
National Strategic Plan for TB Training and Education, 2004 - 2008, Workgroup 2: Public
Health Secror, USA,
http://www.nationaltbcenter.edu/strategicplan/docs/SP_WG2_Public.pdf>.
Mooney, GA & Bligh, JG 1997, 'Information technology in medical education: current and
future applications', Postgraduate Medical Journal, vol. 73, pp. 865-701.
NTAC 2002, National Strategic Plan for TB Control in Aaustralia beyond 2000 National TB
Advisory Committee of Communicable Diseases Nertwork Australia (CDNA),
http://www.health.gov.au/internet/main/publishing.nsf/Content/cda-pubs-other-
tb_plan.htm/$FILE/tbstrat_plan.pdf>.
Oest, Cvd, Chenhall, R, Hood, D & Kelly, P 2005, 'Talking about TB: multicultural diversity
and tuberculosis services in Waikato,New Zealand', Journal of New Zealand Medical
Association, vol. 118, no. 1216.
Orr, KL, C.Golas, K & Yao, K 1993, 'Storyboard Development for Interactive Multimedia
Training', paper presented to 15th Interservice/Industry Training systems and Education
Conference, Orlando, Florida, November 29 - December 2, 1993.
Pacza, T, Steele, L & Tennant, M 2001, 'Development of Oral Health Training for Rural and
Remote Aboriginal Health Workers', Australian Journal of Rural Health, vol. 9, no. 3, pp. 105-
10.
Pawson, R & Tilley, N 1997, Realistic Evaluation, 0 7619 5008 7, SAGE Publications Ltd,
London.
Pellekaan, SMvH & Clague, L 2005, 'Toward health and wellbeing for indigenous Australians',
Postgraduate medical journal, PMJ, no. 81, pp. 618-24.
Phillips, R 1997, The Developer's Handbook to Interactive Multimedia: A practical guide for
educational applications, 0-7494-2121-5, Kogan Page Limited, USA.
Piskurich, GM 1993, Self-directed learning: a practical guide to design, development and
implementation, 1 edn, 1-55542-532-1, Jossey-Bass, San Francisco.
QLDHealth 2010a, Communicable Diseases: a guide for health professionals, Queensland
Government, viewed 15 October 2010
<http://www.health.qld.gov.au/health_prefessionals/diseases/default.asp>.
---- 2010b, Health Professionals - Tuberculosis, Queensland Government, viewed 15 october
2010 <http://www.health.qld.gov.au/qtbcc/healthpro/default.asp>.
QldHS 2007, Queensland Health State-wide Service Plan (2007-2012), Queensland Health
State, 21 July 2009, 9781 921 021 671,
<http://www.health.qld.gov.au/publications/corporate/stateplan2007/QHSHS_plan.pdf>.
19
Rathbone, A 1995, Multimedia & CD-ROMS for Dummies, 2 edn, 1-56884-908-7, IDG Books
Worldwide,Inc.
Riptoningrum, US 2003, 'Development of IMIC Multimedia CD Rom Training Package in
Indonesia', IT Regional education and training, pp. 218-25.
Saethre, EJ 2007, 'Conflicting Traditions, Concurrent Treatment: Medical Pluralosm in Remote
Aboriginal Australia', Oceania Publications, vol. 77, no. 1, pp. 95-110.
Shank, P 2011, The value of Multimedia, 3 October 2011,
<http://www.adobe.com/designcenter/thinktank/valuemedia/The_Value_of_Multimedia.pdf>>.
Simpson, G, Clark, P & Knight, T 2006, 'Changing patterns of tuberculosis in Far North
Queensland', Medical Journal of Australia, vol. 184, no. 5, p. 3.
Soar, J & Yuginovich, T 2006, 'A model for internet-based training to support rural and remote
Practice Nurses in providing sexual and reproductive health education', paper presented to IPSI
2006 Marbella, Spain 10-12 February 2006.
Thomson N, Burns J, Hardy A, Krom I, Stumpers S & B, U 2008, Overview of Australian
Indigenous health status, November 2008, Perth, Western Australia
<http://www.healthinfonet.ecu.edu.au/health-facts/overviews>.
Tomita, M 2003, 'Introduction to CD-ROM Production in Health Education', California
Journal of Health Promotion, vol. 1, no. 1, pp. 60-9.
Uplekar, M, Figueroa-Munoz, J, Floyd, K, Getahun, H, Jaramillo, E, Maher, D, Weil, D &
Williams, B 2006, The Stop TB Strategy, World Health Organization, Stop TB
Partnership<http://whqlibdoc.who.int/hq/2006/WHO_HTM_STB_2006.368_eng.pdf>.
USAID 2011, Infectious Diseases, Tuberculosis, Washington, 18 June 2011,
<http://www.usaid.gov/our_work/global_health/id/tuberculosis/index.html>.
Villamil-Casanova, J & Molina, L 1996, An Interactive Guide to Multimedia 1-57576-066-5,
Indiana.
Werner, D & Bower, B 1982, Helping Health workers learn, 0-942364-10-4, The Hesperian
Foundation, U.S.A.
WHO 1998, Fifty first World Health Assembly, Agenda item 20, Tuberculosis, World Health
Organization, Geneva.
---- 2004, Management of Tuberculosis; Training for Health Facility Staff, World Health
Organization, <http://whqlibdoc.who.int/hq/2004/WHO_HTM_TB_2004.332.pdf>.